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Ono M, Yamaguchi O, Ohtani T, Kinugawa K, Saiki Y, Sawa Y, Shiose A, Tsutsui H, Fukushima N, Matsumiya G, Yanase M, Yamazaki K, Yamamoto K, Akiyama M, Imamura T, Iwasaki K, Endo M, Ohnishi Y, Okumura T, Kashiwa K, Kinoshita O, Kubota K, Seguchi O, Toda K, Nishioka H, Nishinaka T, Nishimura T, Hashimoto T, Hatano M, Higashi H, Higo T, Fujino T, Hori Y, Miyoshi T, Yamanaka M, Ohno T, Kimura T, Kyo S, Sakata Y, Nakatani T. JCS/JSCVS/JATS/JSVS 2021 Guideline on Implantable Left Ventricular Assist Device for Patients With Advanced Heart Failure. Circ J 2022; 86:1024-1058. [PMID: 35387921 DOI: 10.1253/circj.cj-21-0880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Kenji Yamazaki
- Advanced Medical Research Institute, Hokkaido Cardiovascular Hospital
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Teruhiko Imamura
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University
| | - Miyoko Endo
- Department of Nursing, The University of Tokyo Hospital
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Koichi Kashiwa
- Department of Medical Engineering, The University of Tokyo Hospital
| | - Osamu Kinoshita
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Kaori Kubota
- Department of Transplantation Medicine, Osaka University Graduate School of Medicine
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroshi Nishioka
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center
| | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Hospital
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Yumiko Hori
- Department of Nursing and Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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2
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Alam A, Mathew C, Dib E, Jamil A, Guerrero-Miranda C, Lima B, Meyer D, Rafael A, Hall S, Joseph S. Unexpected Twists: A 61-Year-Old Male with Repeated HeartMate II Complications andSubsequent Replacement with HeartMate III. Methodist Debakey Cardiovasc J 2021; 17:68-70. [PMID: 34104324 DOI: 10.14797/zihs8416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
An outflow graft twist of a left ventricular assist device (LVAD) remains a challenging clinical diagnosis and may even be misdiagnosed for other outflow obstructions. We present a case of a patient with two LVAD exchanges due to suspected outflow graft twisting in both clinical scenarios. As new LVADs continue to be designed and upgraded, clinicians must have a high index of suspicion for this rare complication.
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Affiliation(s)
- Amit Alam
- Baylor University Medical Center, Dallas, Texas.,Texas A&M University College of Medicine, Bryan, Texas
| | - Christo Mathew
- Baylor University Medical Center, Dallas, Texas.,Texas A&M University College of Medicine, Bryan, Texas
| | - Elie Dib
- Baylor University Medical Center, Dallas, Texas
| | - Aayla Jamil
- Baylor University Medical Center, Dallas, Texas
| | - Cesar Guerrero-Miranda
- Baylor University Medical Center, Dallas, Texas.,Texas A&M University College of Medicine, Bryan, Texas
| | | | - Dan Meyer
- Baylor University Medical Center, Dallas, Texas
| | - Aldo Rafael
- Baylor University Medical Center, Dallas, Texas
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas.,Texas A&M University College of Medicine, Bryan, Texas
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D'Antonio ND, Maynes EJ, Tatum RT, Prochno KW, Saxena A, Maltais S, Samuels LE, Morris RJ, Massey HT, Tchantchaleishvili V. Driveline damage and repair in continuous-flow left ventricular assist devices: A systematic review. Artif Organs 2021; 45:819-826. [PMID: 33377216 DOI: 10.1111/aor.13901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
With mounting time on continuous-flow left ventricular assist device (CF-LVAD) support, patients occasionally sustain damage to the device driveline. Outcomes associated with external and internal driveline damage and repair are currently not well documented. We sought to evaluate the outcomes of driveline damage and its repair. Electronic search was performed to identify all relevant studies published over the past 20 years. Fifteen studies were selected for analysis comprising of 55 patients with CF-LVAD dysfunction due to driveline damage. Demographic and perioperative variables along with outcomes including survival rates were extracted and pooled for the systematic review. Most patients (53/55) were supported on HeartMate II LVAD (Abbott Laboratories, Abbott Park, IL). Internal damage was more commonly reported than external damage [69.1% (38/55) vs. 30.9% (17/55), P = .01]. Median time to driveline damage was 1.9 years [IQR 1.0, 2.5]. Most patients presented with a CF-LVAD alarm [94.5% (52/55)] and patients with internal driveline damage had a significantly higher rate of alarm activation compared to that observed for those with external damage [38/38 (100%) vs. 14/17 (82.4%), P = .04]. Patients with internal driveline dysfunction were more likely to experience component wear compared to those with external driveline dysfunction [10/38 (26.3%) vs. 0/17 (0%), P = .05]; 14.5% of patients (8/55) underwent external repair of the driveline, 5.5% (3/55) were treated with rescue tape, and 5.5% (3/55) were placed on an ungrounded cable, indicating a short-to-shield event had occurred. A total of 49.1% of patients (27/55) underwent CF-LVAD exchange, 5.5% (3/55) were weaned off the CF-LVAD to explant, and 5.5% (3/55) underwent emergent heart transplantation. The median length of hospital stay was 12 days [IQR 7, 12] and 30-day mortality rate was 14.5% (8/55). Driveline damage was more commonly reported at an internal location and despite being a well-recognized complication, mortality still appears high.
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Affiliation(s)
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert T Tatum
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kyle W Prochno
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Abhiraj Saxena
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Simon Maltais
- Division of Cardiac Surgery, Centre Hospitalié de l'Université de Montréal, Montréal, QC, Canada
| | - Louis E Samuels
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Trinquero P, Pirotte A, Gallagher LP, Iwaki KM, Beach C, Wilcox JE. Left Ventricular Assist Device Management in the Emergency Department. West J Emerg Med 2018; 19:834-841. [PMID: 30202496 PMCID: PMC6123099 DOI: 10.5811/westjem.2018.5.37023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 05/01/2018] [Accepted: 05/31/2018] [Indexed: 11/11/2022] Open
Abstract
The prevalence of patients living with a left ventricular assist device (LVAD) is rapidly increasing due to improvements in pump technology, limiting the adverse event profile, and to expanding device indications. To date, over 22,000 patients have been implanted with LVADs either as destination therapy or as a bridge to transplant. It is critical for emergency physicians to be knowledgeable of current ventricular assist devices (VAD), and to be able to troubleshoot associated complications and optimally treat patients with emergent pathology. Special consideration must be taken when managing patients with VADs including device inspection, alarm interpretation, and blood pressure measurement. The emergency physician should be prepared to evaluate these patients for cerebral vascular accidents, gastrointestinal bleeds, pump failure or thrombosis, right ventricular failure, and VAD driveline infections. Early communication with the VAD team and appropriate consultants is essential for emergent care for patients with VADs.
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Affiliation(s)
- Paul Trinquero
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Andrew Pirotte
- University of Kansas School of Medicine, Department of Emergency Medicine, Kansas City, Kansas
| | - Lauren P Gallagher
- St. Luke's Hospital, Department of Emergency Medicine, New Bedford, Massachusetts
| | - Kimberly M Iwaki
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Christopher Beach
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Jane E Wilcox
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Chicago, Illinois
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5
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Current State and Future Perspectives of Energy Sources for Totally Implantable Cardiac Devices. ASAIO J 2017; 62:639-645. [PMID: 27442857 DOI: 10.1097/mat.0000000000000412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
There is a large population of patients with end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. Implantable cardiac devices, many designated as destination therapy, have revolutionized patient care and outcomes, although infection and complications related to external power sources or routine battery exchange remain a substantial risk. Complications from repeat battery replacement, power failure, and infections ultimately endanger the original objectives of implantable biomedical device therapy - eliminating the intended patient autonomy, affecting patient quality of life and survival. We sought to review the limitations of current cardiac biomedical device energy sources and discuss the current state and trends of future potential energy sources in pursuit of a lifelong fully implantable biomedical device.
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Percutaneous Driveline Fracture After Implantation of the HeartMate II Left Ventricular Assist Device: How Durable is Driveline Repair? ASAIO J 2017; 63:542-545. [DOI: 10.1097/mat.0000000000000531] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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Vierecke J, Schweiger M, Feldman D, Potapov E, Kaufmann F, Germinario L, Hetzer R, Falk V, Krabatsch T. Emergency procedures for patients with a continuous flow left ventricular assist device. Emerg Med J 2016; 34:831-841. [DOI: 10.1136/emermed-2015-204912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/19/2016] [Accepted: 09/23/2016] [Indexed: 11/03/2022]
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Compostella L, Russo N, Setzu T, Bottio T, Compostella C, Tarzia V, Livi U, Gerosa G, Iliceto S, Bellotto F. A Practical Review for Cardiac Rehabilitation Professionals of Continuous-Flow Left Ventricular Assist Devices. J Cardiopulm Rehabil Prev 2015; 35:301-11. [DOI: 10.1097/hcr.0000000000000113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anand J, Singh SK, Hernández R, Parnis SM, Civitello AB, Cohn WE, Mallidi HR. Continuous-flow ventricular assist device exchange is safe and effective in prolonging support time in patients with end-stage heart failure. J Thorac Cardiovasc Surg 2015; 149:267-75, 278.e1. [DOI: 10.1016/j.jtcvs.2014.08.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 07/28/2014] [Accepted: 08/07/2014] [Indexed: 11/26/2022]
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10
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Percutaneous Lead Dysfunction in the HeartMate II Left Ventricular Assist Device. Ann Thorac Surg 2014; 97:1373-8. [DOI: 10.1016/j.athoracsur.2013.11.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/06/2013] [Accepted: 11/11/2013] [Indexed: 11/22/2022]
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Schima H, Stoiber M, Schlöglhofer T, Hartner Z, Haberl T, Zimpfer D. Repair of Left Ventricular Assist Device Driveline Damage Directly at the Transcutaneous Exit Site. Artif Organs 2013; 38:422-5. [DOI: 10.1111/aor.12170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Heinrich Schima
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Department of Cardiac Surgery; Medical University of Vienna; Vienna Austria
- Ludwig-Boltzmann-Cluster for Cardiovascular Research; Vienna Austria
| | - Martin Stoiber
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Ludwig-Boltzmann-Cluster for Cardiovascular Research; Vienna Austria
| | - Thomas Schlöglhofer
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Department of Cardiac Surgery; Medical University of Vienna; Vienna Austria
- Ludwig-Boltzmann-Cluster for Cardiovascular Research; Vienna Austria
| | - Zeno Hartner
- Department of Cardiac Surgery; Medical University of Vienna; Vienna Austria
| | - Thomas Haberl
- Department of Cardiac Surgery; Medical University of Vienna; Vienna Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery; Medical University of Vienna; Vienna Austria
- Ludwig-Boltzmann-Cluster for Cardiovascular Research; Vienna Austria
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Moazami N, Milano CA, John R, Sun B, Adamson RM, Pagani FD, Smedira N, Slaughter MS, Farrar DJ, Frazier OH. Pump replacement for left ventricular assist device failure can be done safely and is associated with low mortality. Ann Thorac Surg 2012; 95:500-5. [PMID: 23261114 DOI: 10.1016/j.athoracsur.2012.09.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/28/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although continuous-flow left ventricular assist devices (LVAD) are durable and reliable, device replacement will be inevitable in some patients. We evaluated the incidence and outcomes of pump replacement procedures with the HeartMate II (Thoratec Corporation, Pleasanton, CA) LVAD. METHODS Data were obtained from 1,128 patients implanted from March 2005 to January 2010 with the HeartMate II during the clinical trials for bridge to transplant and destination therapy. The operative mortality associated with the replacement procedure was determined. RESULTS The mean duration of HeartMate II support was 568 ± 535 days (cumulative duration: 1,755 patient-years, longest: 6.5 years). A total of 72 (6.4%) patients underwent 79 LVAD replacements (0.045 events/patient-year) of which 2 were in the initial operation and 77 in separate procedures. Reasons for replacement were percutaneous lead damage (36 events, 3.0%), device thrombosis (25 events, 2.1%), infection (7 events, 0.6%), and miscellaneous other (11 events, 0.9%). The median time to pump replacement was 428 days (range 0 to 1,474). Of the 77 replacement procedures, there were 5 (6.5%) operative deaths within 30 days. The causes of death were device thrombosis, right heart failure, multisystem organ failure, and bleeding. One year after exchange (median 2.1 years after initial implant), 30% had died, 5% were transplanted, and 65% were ongoing and alive. CONCLUSIONS HeartMate II device failure requiring pump replacement is infrequent, but when required can be done safely. These data continue to provide encouraging evidence supporting HeartMate II use for long-term circulatory support.
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Affiliation(s)
- Nader Moazami
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Abdominal X-ray imaging for detection of left ventricular assist device driveline damage. J Heart Lung Transplant 2012; 31:1313-5. [DOI: 10.1016/j.healun.2012.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/30/2012] [Accepted: 09/14/2012] [Indexed: 11/22/2022] Open
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Stulak JM, Cowger J, Haft JW, Romano MA, Aaronson KD, Pagani FD. Device exchange after primary left ventricular assist device implantation: indications and outcomes. Ann Thorac Surg 2012; 95:1262-7; discussion 1267-8. [PMID: 23063192 DOI: 10.1016/j.athoracsur.2012.08.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 08/03/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients are being supported for longer periods with implantable left ventricular assist devices (LVADs) owing to longer transplantation wait times and approval of LVADs for destination therapy. This comes with an increased potential need for device exchange when complications arise. There are few data examining this patient population. METHODS Between August 1998 and January 2012, 45 patients (34 men) underwent 57 device exchanges after primary pulsatile or continuous-flow LVAD implantation. The median age at the initial LVAD implantation was 58 years (range, 28-78 years) and the median time to first device exchange was 15 months (range, immediate-56 months). Indications for primary LVAD included bridge to transplantation in all but 10 patients, and devices included the HeartMate I (Thoratec, Pleasanton, CA) in 16 patients, the HeartMate II (Thoratec) in 21 patients, the HeartWare HVAD (HeartWare, Framingham, MA) in 2 patients, the DuraHeart I (Terumo Heart, Ann Arbor, MI) in 1 patient, and other devices in 5 patients. Indications for reoperation included device/component failure (n=24), major driveline infection (n=15), pump thrombus (n=15), and other indications (n=2). RESULTS Pumps implanted in 57 reoperations included the HeartMate I in 15 patients, the HeartMate II in 35 patients, the HeartWare HVAD in 2 patients, the DuraHeart I in 2 patients, and other devices in 3 patients. Early mortality occurred in 2/57 (3.5%) patients. Median follow-up was 18 months (range, 1-113 months); median length of LVAD therapy after the first device exchange was 13 months (range, 1-59 months). Actuarial 1-year survival and freedom from repeated device exchange after the first exchange was 89% and 79%, respectively. CONCLUSIONS Device exchange may be required after LVAD implantation. This can be performed with low early mortality and no adverse effect on late survival. Multiple reoperations may be required in some patients.
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Affiliation(s)
- John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
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17
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Recurrent driveline “twiddling”. J Heart Lung Transplant 2010; 29:910-1. [DOI: 10.1016/j.healun.2010.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 04/07/2010] [Accepted: 04/07/2010] [Indexed: 11/18/2022] Open
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